Download athens-2005-s7

EMERGING REALIZATION
Theoretical considerations
(one model shortcomings,
translation into another
conceptual language)
Practical experience
Integrative
(unsatisfactory effectiveness
approaches
of one standard modality)
in psychotherapy
Therapeutic pragmatism
(maximization of effectiveness,
abbreviation of treatment)
Integration
=
eclecticism
Integration
=
coexistence of 2 or 3
discordant models
Integration
=
formation of an overarching context giving
coherence & coordinating treatment
SOURCES OF THEORETICAL INTEGRATION IN C.A.T.
PSYCHOANALYTIC
COGNITIVE
PSYCHOLOGY
(problem solving,
cognitive
mediation of
action)
THEORY
VYGOTSKY
(object relations
theory)
(social activity
theory)
CAT
COGNITIVE –
KELLY
(personal
construct
theory)
BEHAVIORAL
THERAPIES
(planning & measu-
rement of change,
self-monitoring)
BAKHTIN
(dialogical
model)
ARTIFICIAL
INTELLIGENCE
(feedback, flow
charts)
COGNITIVE ANALYTIC THERAPY (CAT)
Brief, integrated, structured cognitive therapy
A. Ryle, early ’80s
case reformulation
- text
- diagrammatic
- aims
1
16
4-6
FU
sessions material
sessions material
self-monitoring
self-monitoring
questionnaires
progress chart
WRITTEN / VISUAL AIDS USED IN CAT
(VYGOTSKIAN “TOOLS”)
PATIENT’S
THERAPIST’S
 questionnaires & tests
 case reformulation
 letters (good-bye l. & others)
 text
 biographical accounts
 sequential diagrammatic (of
 self-characterizations
self-states, reciprocal roles,
 self-monitoring of symptoms
problematic procedures)
& problematic procedures
 letters (good-bye l. & others)
 diary keeping
 instructions
 progress rating
INDIVIDUAL TECHNIQUES USED IN CAT
ALWAYS WITHIN THE CONTEXT OF THE CAT UNDERSTANDING
 COGNITIVE: concept formation & elaboration, cognitive distortions
treatment, etc
 PSYCHODYNAMIC: clarification, confrontation
 BEHAVIORAL: exposure, thought stopping, role playing, self-monitoring,
self-assertion, etc
 OTHERS: Gestalt, etc
 PATIENT’S CONTRIBUTIONS
good enough,
depriving,
conditionally good
rejecting
coping
deprived,
abandoned
AIM:
fearful
collect coping
obsession
experiences &
(“down in the
dumps”)
acknowledge
them
thought
stopping
alone, vulnerable,
cognitive
restructuring,
ignorant, incompetent
confrontation
bulimia
empty, hopeless
response
prevention
a failure
depressed, undeserving
obsession
(bad, “unworthy
Christian”)
thought
stopping
Self – self role procedures
CAT is NOT opposite to the use of medication when it is deemed
necessary
The use of medication is treated as a tool carrying & creating
meaning
within the context of reciprocal role relationships between
patient & therapist
fragile autonomy
M
ideal care-giver,
helpful sage
thankfully
needy,
submissive
ideally cared for
improvement
threatened,
menacing
intruder
relatively in control,
counter-
regains self-esteem
attacking
M
passive resistance
(“forgetting”, incosistant)
deterioration
active rejection
(stop)
needy